title: Rapid emergence of echinocandin resistance in Candida glabrata resulting in clinical and microbiologic failure.
abstract: We report a case of Candida glabrata candidemia that developed resistance to micafungin within 8 days of initiation of therapy in a patient without previous echinocandin exposure or other known risk factors for clinical or microbiological failure. Pre- and postresistant isolates were confirmed to be isogenic, and sequencing of hot spots known to confer echinocandin resistance revealed a phenylalanine deletion at codon 659 within FKS2.
authors.affiliation: University Health System, Department of Pharmacy, San Antonio, Texas, USA. james.lewis@uhs-sa.com
authors.forename: James S
authors.initials: JS
authors.lastname: Lewis
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Wiederhold
authors.forename: Brian L
authors.initials: BL
authors.lastname: Wickes
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.forename: James H
authors.initials: JH
authors.lastname: Jorgensen
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D041221:Candida glabrata / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology; D025141:Drug Resistance, Fungal / Q000187:drug effects / Q000235:genetics*; D054714:Echinocandins / Q000494:pharmacology*; D005260:Female; D005656:Fungal Proteins / Q000235:genetics* / Q000378:metabolism; D005964:Glucosyltransferases / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009154:Mutation; D017422:Sequence Analysis, DNA; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D005964:Glucosyltransferases